3D laparoscopic surgery as an alternative approach for the surgical management of abdominopelvic melanoma metastases

Recent advancements in adjuvant therapy have led to improved survival in metastatic melanoma. Despite this, patients can be left with residual metastases that may benefit from surgical resection. There may be difficulty in access to certain anatomical locations (i.e., the pelvis) with standard open surgical techniques. We aimed to investigate whether 3D laparoscopy can be a useful adjunct in this setting. Four consecutive patients with abdominopelvic metastatic melanoma are presented. All four patients previously had primary surgery for cutaneous melanoma of the lower limb and were receiving adjuvant therapy for metastatic disease. In all four patients, liver metastases resolved following interval PET-CT scanning but a single abdominopelvic metastasis showed no response to systemic therapy. All patients underwent resection of these metastases as a joint procedure with both a 3D laparoscopic surgeon and a melanoma surgeon. All pre-operatively identified residual metastases were completely excised using 3D laparoscopy. Interval PET-CT scanning at 6 weeks showed no evidence of metastatic disease (n = 4). Our Specialist Skin Cancer Multidisciplinary Team (SSMDT) has access to open, 3D laparoscopic, and robotic surgeries which we offer on an individualized basis to our patients with oligometastatic disease. Although we have no statistically significant quantitative data to support this, we believe that 3D laparoscopy is an important surgical adjunct which we can more flexibly and efficiently deploy versus robotic surgery, enabling patient to benefit from 3D optics with reduced propensity for delay. Further collaborative research is warranted to establish whether its use reduces morbidity and improves outcomes.